Anemia: Fast Facts (Peer reviewed publications)
Study shows the financial burden of anemia in patients on chemotherapy
A recent retrospective study was conducted to evaluate the effect of anemia on the costs related to cancer treated with chemotherapy. A commercial claims database was studied for the years 1999 to 2000, and patients who received chemotherapy within 6 months of their cancer diagnosis were identified. A total of 619 patients were studied and 25% had anemia. Increased expenditures were associated with the presence of anemia and extended durations of EPO treatment. Short term disability days and mean monthly healthcare expenditures were analyzed. Economic evaluation determined the incremental costs due to anemia in patients on chemotherapy in the first 6 months after diagnosis were 5,538.00, with 10.8% of that figure being attributed to short-term disability leave. The researchers concluded, "Anemia in patients undergoing chemotherapy presents a substantial burden to employers and payers. In addition, patients with anemia treated with erythropoietin alfa can achieve expenditure levels similar to those patients without anemia."
Source: Berndt E, Crown W, Kallich J, et al. The impact of anaemia and its treatment on employee disability and medical costs. Pharmacoeconomics. 2005;23(2):183-92.
Meta-analysis reviews overall survival in cancer patients treated with recombinant human erythropoietin
A recent meta-analysis was conducted to evaluate the efficacy of anemia treatment in cancer patients in relation to red blood cell transfusions, searching databases such as the Cochrane Library, Medline, and EMBASE. Randomized controlled trials of recombinant human erythropoietin (EPO) compared with no erythropoietin treatment were included in the review. The review identified 27 clinical trials and encompassed 3,287 patients. Favorable response to EPO was most likely in patients with baseline hemoglobin levels less than 10 g/dL. The risk for blood transfusion was decrease in patients treated with EPO compared to patients who were not on EPO therapy. When reviewing the risks of EPO therapy, the relative risk of thromboembolic complications were not increased with treatment; however, the evidence was suggestive of (not conclusive of) the fact that EPO may enhance patient survival. The researchers felt the results of the meta-analysis showed EPO treatment may reduce the risk for blood transfusions and improve hematologic response in cancer patients; however, data from 2 large studies are contradictory to these findings. The authors felt this disparate data may be due to, "Differences in study population and design, higher target hemoglobin levels and higher risk of thromboembolic complications, and concerns that erythropoietin may stimulate tumor growth."
Source: Bohlius J, Langensiepen S, Schwarzer G, et al. Recombinant human erythropoietin and overall survival in cancer patients: results of a comprehensive meta-analysis. J Natl Cancer Inst. 2005;97:489-498
Researchers find no link between administration of cisplatin and worsening of erythropoietin response to anemia
A study was conducted on 3 groups of patients to evaluate the effects of cisplatin on erythropoietin (EPO) response to anemia. Group A included 15 naive cancer patients, group B was assigned 15 cancer patients who had become anemic from previous treatment with 3 cycles of cisplatin chemotherapy, and group C consisted of 15 patients with iron deficiency anemia and no cancer. Groups A, B, and C showed no difference in their mean hemoglobin values, but EPO levels significantly lower in Groups A and B versus Group C. The researchers stated, "The study findings demonstrated the known association between cancer and inadequate EPO response to anemia, but showed cisplatin did not lead to further deterioration."
Source: Arslan M, Evrensel T, Kurt E, et al. Comparison of the serum erythropoietin levels in chemotherapy-naive and cisplatin-treated cancer patients. Neoplasma. 2005;52:43-45
Review paper compares systematic reviews on outcomes with epoetin use
A paper published in the medical journal Best Practice and Research Clinical Haematology, Djulbegovic reviews the findings of two groups, the Blue Cross and Blue Shield Association Technology Evaluation Center and the Cochrane Review Group, who have summarized evidence regarding EPO treatment for anemia related to cancer treatment. The author discusses the 8 clinical circumstances identified by an ASH/ASCO guideline panel in which EPO administration may be considered. The strengths and limitations of reviews were discussed, with additional discussion centering around the lack of high-powered evidence showing improvement on symptoms, fatigue, or quality of life with EPO treatment. The author states the purpose of the paper is to "compare and contrast the findings from the guidelines set by ASH/ASCO that have been culled from two large systematic reviews."
Source: Djulbegovic B. Erythropoietin use in oncology: a summary of the evidence and practice guidelines comparing efforts of the Cochrane Review group and Blue Cross/Blue Shield to set up the ASCO/ASH guidelines. Best Pract Res Clin Haematol. 2005;18:455-466
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